Evaluation of the Early Functional Outcome Following Arthroscopic Partial Meniscectomy for Meniscal Tears

Meniscal tears are among the common knee pathologies which affect activities of daily living if not managed properly. Arthroscopic knee surgery is an evolving procedure in our environment and patient satisfaction with this procedure needs to be evaluated. This was a prospective study carried out between June 2017 and May 2018 with the aim to determine the effectiveness of Arthroscopic Partial Meniscectomy in the management of meniscal tears in our environment. The Western Ontario Meniscal Evaluation Tool (WOMET) Knee Score was used to assess patient satisfaction with this procedure. A total of thirty-one patients were recruited into the study consisting of eighteen males and thirteen females with an average age of thirteen years (17 - 48 years) who underwent arthroscopic partial meniscectomy. Preoperative and postoperative knee scores at 6 weeks and 12 weeks were compared using the Western Ontario Meniscal Evaluation Tool. At the end of the study period, data collated were analyzed using the specified tools. In terms of clinical outcomes, arthroscopic partial meniscectomy showed statistically significant improvement of symptoms as evidenced by a mean knee score of 75.6 (SD 9.3) at 6 weeks, 87.7 (SD 4.7) at 12 weeks compared with a preoperative knee score of 46.7. Medial meniscal tears were more common than lateral meniscal tears in all age groups and both sexes recruited into the study. The most common type of meniscal tear seen was the longitudinal type of tear while complex tear is the least type of tear seen. The surgery (arthroscopic partial meniscectomy) is an evolving area of sports medicine that requires sub-specialization, however solves the problem of increased mobility following open surgery. This study will tend to add to existing knowledge as patients who are mostly sports inclined can return to play very early with better outcome scores as regards pain and function.

Antioxidant Protection Mechanisms Reveal Significant Response in Drought-Induced Oxidative Stress in Some Traditional Rice of Assam, India

Drought tolerance levels and antioxidant protection mechanisms were evaluated for 21 traditional rice varieties of Assam, India, along with Sahbhagi Dhan （drought tolerant） and IR64 （drought sensitive） as controls. Drought was imposed in hydroponic culture with polyethylene glycol 6000 （PEG6000） that was initially standardized with different concentrations. All the rice varieties showed apparent decreases in growth characteristics under drought stress （initially at 15% for 7 d followed by 20% PEG6000 for 7 d in Yoshida medium）. On the basis of standard evaluation score （SES）, eight rice varieties showed high drought tolerance which were carried forward for further biochemical analyses. Based on different morpho- physiological parameters, SN03 （Bora）, SN04 （Prosad Bhog）, SN05 （Kola Joha）, SN06 （Helash Bora）, SN08 （Salihoi Bao）, SN12 （Kola Amona）, SN20 （Ronga Bora） and SN21 （Sok-Bonglong） were identified as promising drought tolerant varieties. The non-enzymatic antioxidants activities viz., glutathione, ascorbate and enzymatic antioxidant activities such as superoxide dismutase （SOD）, catalase （CAT）, guaiacol peroxidase （GPX）, ascorbate peroxidase （APX）, glutathione reductase （GR） in shoots and roots of all the selected varieties revealed significant level of protection mechanisms as compared with controls. Enhancement in activities of the overall antioxidant enzymes including SOD, GPX, CAT, GR and APX under drought stress reflects their role in the adaptation process under water stress.

Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis

BACKGROUND Acute mesenteric venous thrombosis(AMVT)can cause a poor prognosis.Prompt transcatheter thrombolysis(TT)can achieve early mesenteric revascularization.However,irreversible intestinal ischemia still occurs and the mechanism is still unclear.AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed.We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.RESULTS Among 58 patients,prompt TT was carried out 28.5 h after admission.A total of 42(72.4%)patients underwent arteriovenous combined thrombolysis,and 16(27.6%)underwent arterial thrombolysis alone.The overall 30-d mortality rate was 8.6%.Irreversible intestinal ischemia was indicated in 32(55.2%)patients,who had a higher 30-d mortality and a longer in-hospital stay than patients without resection.The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation(APACHE)II score(odds ratio=2.368,95% confidence interval:1.047-5.357,P=0.038)and leukocytosis(odds ratio=2.058,95% confidence interval:1.085-3.903,P=0.027).Using the receiver operating characteristic curve,the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12×10^9/L,respectively.CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients.High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia.Therefore,close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia,in whom ultimately surgical resection is required,before the initiation of TT.

Multicentered prospective investigator initiated study to evaluate the clinical outcomes with extracorporeal cytokine adsorption device (CytoSorb®) in patients with sepsis and septic shock

BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection.The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production:The cytokine storm.Hemoadsorption by CytoSorb®therapy is a new technology that helps to address the cytokine storm and to regain control over various inflammatory conditions.AIM To evaluate prospectively CytoSorb®therapy used as an adjunctive therapy along with standard of care in septic patients admitted to intensive care unit(ICU).METHODS This was a prospective,real time,investigator initiated,observational multicenter study conducted in patients admitted to the ICU with sepsis and septic shock.The improvement of mean arterial pressure and reduction of vasopressor needs were evaluated as primary outcome.The change in laboratory parameters,sepsis scores[acute physiology and chronic health evaluation(APACHE II)and sequential organ failure assessment(SOFA)]and vital parameters were considered as secondary outcome.The outcomes were also evaluated in the survivor and nonsurvivor group.Descriptive statistics were used;a P value<0.05 was considered RESULTS Overall,45 patients aged≥18 and≤80 years were included;the majority were men(n=31;69.0%),with mean age 47.16±14.11 years.Post CytoSorb®therapy,26 patients survived and 3 patients were lost to follow-up.In the survivor group,the percentage dose reduction in vasopressor was norepinephrine(51.4%),epinephrine(69.4%)and vasopressin(13.9%).A reduction in interleukin-6 levels(52.3%)was observed in the survivor group.Platelet count improved to 30.1%(P=0.2938),and total lung capacity count significantly reduced by 33%(P<0.0001).Serum creatinine and serum lactate were reduced by 33.3%(P=0.0190)and 39.4%(P=0.0120),respectively.The mean APACHE II score was 25.46±2.91 and SOFA scores was 12.90±4.02 before initiation of CytoSorb®therapy,and they were reduced significantly post therapy(APACHE II 20.1±2.47;P<0.0001 and SOFA 9.04±3.00;P=0.0003)in the survivor group.The predicted mortality in our patient population before CytoSorb®therapy was 56.5%,and it was reduced to 48.8%(actual mortality)after CytoSorb®therapy.We reported 75%survival rate in patients given treatment in<24 h of ICU admission and 68%survival rates in patients given treatment within 24-48 h of ICU admission.In the survivor group,the average number of days spent in the ICU was 4.44±1.66 d;while in the nonsurvivor group,the average number of days spent in ICU was 8.5±15.9 d.CytoSorb®therapy was safe and well tolerated with no adverse events reported.CONCLUSION CytoSorb®might be an effective adjuvant therapy in stabilizing sepsis and septic shock patients.However,it is advisable to start the therapy at an early stage(preferably within 24 h after onset of septic shock).

Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients

Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging tests.The mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic interventions.This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.Methods:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June 2018.Patients were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following infection.Other inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection.Patients were shortly follow-up for the 28-day mortality.Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome.The receiver operating characteristic curves were also done for MEDS and SPEED scores.Results:Among the 61 patients,41 died with the mortality rate of 67.2%.The mortality rate increased with a higher SPEED and MEDS scores.Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors(p=0.004 and p<0.001,respectively),indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients.Thereafter,the receiver operating characteristic curves were plotted,which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87(0.788-0.963)as compared with 0.75(0.634-0.876)for MEDS.Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system.For every one unit increase in SPEED score,the odds of 28-day mortality increased by 37%.Conclusion:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients.Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.